CANCER:

Cancer death rates are decreasing over time. According to the CDC, from 2001 to 2020 cancer death rates went down 27%, and continue to decrease. Even still... CANCER IS THE SECOND LEADING CAUSE OF DEATH IN THE US - ONE IN EVERY 4 DEATHS IS DUE TO CANCER.

Leading causes of new cancer cases (2019 CDC data):

1)Female Breast, 2)Prostate, 3)Lung, 4)Colorectal, 5)Uterine, 6)Melanoma, 7)Urinary/Bladder, 8)Non-Hodgkin Lymphoma, 9)Kidney, 10)Leukemias

NATIONAL AVERAGE - NEW CANCER DIAGNOSES: 439 per 100,000

STATE WITH HIGHEST FREQUENCY OF NEW CANCER DIAGNOSES: KENTUCKY (504.9 per 100,000)

STATE WITH LOWEST FREQUENCY OF NEW CANCER DIAGNOSES: ARIZONA (358.7 per 100,000)

MISSOURI - 442.5 per 100,000

KANSAS - 452.2 per 100,000

Leading causes of death from cancer in the USA (2019 CDC data): 

1.Lung, 2.Female Breast, 3.Prostate, 4.Colorectal 5.Pancreatic, 6.Liver/Bile Duct, 7.Ovarian, 8.Leukemia, 9.Uterine, 10.Non-Hodgkin Lymphoma

NATIONAL AVERAGE - CANCER DEATHS: 144.1 per 100,000

STATE WITH HIGHEST FREQUENCY OF CANCER DEATHS: KENTUCKY (177.3 per 100,000)

STATE WITH LOWEST FREQUENCY OF CANCER DEATHS: UTAH (119.5 per 100,000)

MISSOURI - 157.9 per 100,000

KANSAS - 151.4 per 100,000

SCREENING RECOMMENDATIONS:

BLADDER CANCER - 4th most common cancer in men, 9th in women

--> insufficient evidence to assess benefits vs harm in screening (basic urine test) for those without symptoms

-->WHY? MANY FALSE POSITIVE RESULTS, meaning unnecessary additional procedures/tests that may cause harm/excessive anxiety

--> Common Symptoms - blood in urine, or other sudden change or symptoms in the lower urinary tract

BREAST CANCER - 2nd-leading cause of cancer deaths in women. Usually diagnosed at ages 55-64. Age is the most important risk factor.

--> WHEN TO SCREEN: Starting age 50 (but earlier depending on multiple factors)

--> MAMMOGRAM - recommended in women every other year, from ages 50-74 (before age 50 & beyond age 74 is case-by-case)

--> BRCA 1/2 genetic testing - RISK ASSESSMENT TOOL (to determine whether genetic counseling is necessary, and afterwards consider testing)

--> Routine breast self-exams are NOT recommended (high false-positive rate)

--> Risk-Reducing medications (estrogen blockers) are to be offered for women ages 35+ who are at increased risk of breast cancer

CERVICAL CANCER - decreasing in the USA, as of 2015 down to 2.3 deaths per 100,000 persons

--> WHEN TO SCREEN: Starting at age 21

--> Cervical Cytology (Speculum Exam or "PAP" test) recommended every 3 years ages 21-29

--> Pap every 3 years ages 30-65 years, OR Pap + high-risk HPV virus testing every 5 years

--> Screening is NOT recommended for: age<21, age>65, or in women with hysterectomy but NO history of high-grade precancerous lesions.

COLON (COLORECTAL) CANCER - 3rd leading cause of cancer death in men and women, usually diagnosed ages 65-74.

***Currently 31.2% of adults are NOT up to date with screening!

--> WHEN TO SCREEN: Starting at age 45 (or 10 years prior to diagnosis in a first-degree relative)

--> GOLD STANDARD = colonoscopy screening (every 10 years unless otherwise specified)

--> Other Options:

-----> Cologard (DNA-FIT testing) every 1-3 years

-----> High-Sensitivity Guaiac Fecal Occult Blood Test (HSgFOBT) or Fecal Immunochemical Test (FIT) every year

-----> Flexible Sigmoidoscopy every 5 years (or every 10 years when added with FIT test)

-----> CT colonography every 5 years

--> Use of Aspirin for colorectal cancer prevention is not recommended (multiple studies show no net benefit)

LUNG CANCER - 2nd most diagnosed cancer, currently the leading cause of cancer death. Most important risk factor: SMOKING (any type) which accounts for 90% of all new diagnoses. Average age at diagnosis: 70 years

--> WHEN TO SCREEN: Age 50 (in smokers who have smoked 20-pack years*)

--> Annually screen ages 50-80 with 20-pack year history (stops early when a person has been smoke-free for 15 years)

*20-pack years means 1 pack per day for 20 years, 2 packs a day for 10 years, 1/2 pack per day for 40 years, etc.

ORAL & PHARYNGEAL CANCER (lip, mouth, nose, throat)

--> Biggest risk factors: Tobacco and alcohol use - these are declining over time

--> Other risk factors: HPV (usually from oral sex) - this is a rising risk factor

--> Inadequate evidence that screening for oral cancer improves lifespan or changes quality of life (need better methods to detect)

OVARIAN CANCER - 5th most common cause of cancer deaths among women (over 95% ages 45+, avg age 63)

--> CA-125 blood test has a low positive predictive value (positive test = more likely to NOT have ovarian cancer than have ovarian cancer)

--> Transvaginal Ultrasound can detect between 80-100% of ovarian cancers, however it is too difficult to determine cancer vs cysts or endometriosis

--> HIGH RISK INDIVIDUALS - especially BRCA 1 or 2 genetic mutation with high-risk family history (or Lynch syndrome) = screening recommended starting at age 30 (earlier in some cases) using both ultrasound AND CA-125 testing.

PANCREATIC CANCER - uncommon cancer, however this is the 3rd most common cause of cancer death in the USA.

--> Screening is NOT recommended for the general population

--> High risk individuals (family history, heredetary pancreatitis, Peutz-Jeghers syndrome, Lynch syndrome) may undergo CT, MRI, or esophageal ultrasound

--> CA 19.9 biomarker (blood test) may be useful in high-risk individuals, but has a high false-positive rate (positive result, but no cancer present)

PROSTATE CANCER - common cancer in men. 33% of men age 70's have it (11% of men diagnosed in their lifetime, 2.5% overall risk of death)

--> Large majority of prostate cancer is non-invasive and not related to death in most cases

--> AAFP does not recommend PSA testing OR rectal exam (see THIS video about PSA testing)

--> The good: PSA testing prevents approximately 1.3 deaths per 1,000 individuals over a 13 year-span

--> The bad: A high false-positive rate (abnormal finding but no cancer) often leads to unnecessary biopsies, chronic pain, impotence, and other problems

--> The Ugly: Overdiagnosis leads to more surgeries/treatments that may cause erectile dysfunction, incontinence, chronic pain, and depression.

--> Most prostate cancers require no intervention

--> FALSE POSITIVE RATE: 15% of men over the course of a 10-year span of surveillance

SKIN CANCER - melanoma, squamous cell, and basal cell cancers.

--> Current recommendation by USPSTF: evidence is insufficient and balance of benefit vs harm cannot be determined (screening not defined)

--> Visual detection by clnicians is currently recommended (See ABCDE rule HERE). Concerns exist regarding excessive biopsies.

--> Virtue Medical does recommend skin exams - particularly in those with excessive sunlight exposure history.

--> Dermatology evaluation is recommended in any case of abnormal skin findings or where a concern about skin cancer exists.

TESTICULAR CANCER - most common cancer in males ages 15-34, but rare (5.4 per 100,000 males)

--> Current recommendations by USPSTF: Screening not recommended (small to no benefit due to rarity AND high cure rate)

--> Symptoms: Lump or enlarged testicle, heaviness sensation in the scrotum, dull ache in groin, scrotal or low back pain.

THYROID CANCER - on the rise since 1970's (many postulated reasons), however 5-year survivall has significantly improved

--> Current recommendations by USPSTF: Screening not recommended (rare and no significant change in outcome with screening)

--> Most cases have a good prognosis (5-year survivall rate overall is 98.1%)

--> Types of thyroid cancer: Papillary (most common), Follicular, Medullalry, Hurthle cell, and Anaplastic (least common)

--> Symptoms: Lump/mass in neck, feeling of neck tightness, difficulty with speaking and/or swallowing, neck pain

DIABETES (Elevated blood sugars due to inadequate insulin levels OR inadequate insulin sensitivity)

- How is this accomplished? Fasting glucose, A1c level, and/or an oral glucose tolerance test (OGTT).

POSITIVE RESULT: Fasting blood sugar ≥ 126, A1c ≥ 6.5%, or 2-hour post-load glucose level ≥ 200

- Who is this screening for? The USPSTF and AAFP agree that:

1) Individuals aged 40-70 who are overweight (BMI >25) or obese (BMI ≥ 30) should be screened

2) Pregnant women at 24 weeks gestational age should be screened using an oral glucose test

- Other Notes:

--- Annual or "routine" labs include glucose & A1c, even at earlier ages.

--- There is disagreement on screening for diabetes in NON-pregnant individuals before the age of 40.

--- Virtue Medical DOES screen for diabetes with all routine/annual/physical labs.

GFDS